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Nurse-Family Partnership

Categories

Categories associated with best practice:

Determinants of Health: Personal health practices and coping skills, Social support networks, Access to health services, Healthy child development

Overview

Nurse-Family Partnership (NFP) is a prenatal and infancy nurse home visitation program that aims to improve the health, well-being, and self-sufficiency of low-income, first-time parents and their children. NFP was founded on concepts of human ecology, self-efficacy, and human attachment. Its program activities are designed to link families with needed health and human services, promote good decision-making about personal development, assist families in making healthy choices during pregnancy and providing proper care to their children, and help women build supportive relationships with families and friends. Nurses follow a detailed, visit-by-visit guide that provides information on tracking dietary intake; reducing cigarette, alcohol, and illegal drug use; identifying symptoms of pregnancy complications and signs of children’s illnesses; communicating with health care professionals; promoting parent-child interactions; creating safe households; and considering educational and career options.

Program objectives include decreased substance use, improved maternal economic self-sufficiency, fewer subsequent unintended pregnancies, reduced child abuse and neglect, and improved school readiness of the children. Individual programs serve a minimum of 100-200 families and are supported by 4-8 trained registered nurse home visitors (each carrying a caseload of 25 families), a nurse supervisor, and administrative support. Nurse home visits begin early in pregnancy and continue until the child’s second birthday. The frequency of home visits changes with the stages of pregnancy and infancy and is adapted to the mother’s needs, with a maximum of 13 visits occurring during pregnancy and 47 occurring after the child’s birth.

Several evaluations, including randomized controlled trials, have consistently demonstrated the intervention’s positive impact on maternal and child health, including: improved maternal sense of master and self-sufficiency, fewer incidences of childhood injuries and maltreatment, fewer subsequent pregnancies and increased intervals between children, improved prenatal health, and less frequent smoking, improved academic indicators for child, and use of alcohol and drugs among children at follow-up.

Intervention Focus

To help women improve the outcomes of pregnancy by improving their health-related behaviors

Individual level

People living in conditions of disadvantage are explicitly stated to be a target population of the intervention.

To improve the health and development of the child by helping parents provide responsible and competent care in the first 2 years of life

Individual level

Interpersonal level

People living in conditions of disadvantage are explicitly stated to be a target population of the intervention.

To help parents become economically self-sufficient by helping them plan future pregnancies, complete their education, and find work

Individual level

People living in conditions of disadvantage are explicitly stated to be a target population of the intervention.

Health Issue(s) that is/are addressed by the Intervention

Health Promotion

Healthy Eating

Heathy Literacy

Maternal and Infant Health

Mental Health

Risk Reduction

Prevent/reduce alcohol use/abuse

Prevent/reduce tobacco use

Prevent/reduce illegal drug use/abuse

Prevent/reduce misuse of medications

Prevent injury

Prevent violence

Specific Activities of the Intervention

Educational health information offered

Information sessions offered about a risk factor or
condition

Other training session

Other

Priority/Target Population for Intervention Delivery

Life Stage

Prenatal

Infancy (birth to 2 years)

Youth (age 13-18 years)

Young adult (age 19-24 years)

Adults (age 25-64 years)

Settings

Educational Settings

Community Setting

Home

Outcomes

Outcomes and Impact Chart

Level of Impact

Description of Outcome

Equity Focus

Individual Level

Nurse-visited children were less likely to be classified as having total emotional behavioral problems at age 6 years (relative risk [RR] = 0.45, P = .08). Paraprofessional-visited children born to low resource mothers compared with control group counterparts exhibited less dysregulated aggression (ES = ?0.36, P = .02) and fewer incoherent stories (ES = ?0.50, P = .002) in response to the MSSB and better behavioral regulation during testing (ES = 0.32, P = .05).

These program effects were not more pronounced among those with the dual risks of having mothers with low psychological resources and living in more disadvantaged neighborhoods at registration during pregnancy.

Outcomes reported for people living in conditions of disadvantage are compared to outcomes for people living in more advantaged conditions.

Individual Level

Nurse-visited children were less likely to have been classified as having internalizing problems at age 9 years (RR = 0.44, P = .08). This program effect was not more pronounced among those with the dual risks of having mothers with low psychological resources and living in more disadvantaged neighborhoods at registration during pregnancy.

Outcomes reported for people living in conditions of disadvantage are compared to outcomes for people living in more advantaged conditions.

Individual Level

Nurse-visited children were less likely to have been classified as having dysfunctional attention at age 9 years (RR = 0.34, P = .07). This program effect was not more pronounced among those with the dual risks of having mothers with low psychological resources and living in more disadvantaged neighborhoods at registration during pregnancy.

Outcomes reported for people living in conditions of disadvantage are compared to outcomes for people living in more advantaged conditions.

Individual Level

Nurse-visited children born to low-resource mothers compared with their control group counterparts had better receptive language scores averaged over ages 2, 4, and 6 years (ES = 0.30, P = .01), although the difference at age 6 years was not statistically significant (ES = 0.21, P = .16).They also had better sustained attention averaged over ages 4, 6, and 9 years (ES = 0.36, P = .006), at age 6 years (ES = 0.33, P = .048), and at age 9 years (ES = 0.33, P = .08). The nurse effects on child cognition, language, and achievement were more pronounced among children born to mothers with low psychological resources and who lived in the most disadvantaged neighborhoods, but the number of cases living in the most disadvantaged neighborhoods was small, introducing instability in estimates.

Outcomes reported for people living in conditions of disadvantage are compared to outcomes for people living in more advantaged conditions.

Individual Level

Paraprofessional-visited children born to mothers with low psychological resources compared with control group counterparts exhibited fewer errors in visual attention/task switching at age 9 years (effect size = ?0.30, P = .08). This program effect was not more pronounced among those with the dual risks of having mothers with low psychological resources and living in more disadvantaged neighborhoods at registration during pregnancy. There were no statistically significant paraprofessional effects on other primary outcomes.

Outcomes reported for people living in conditions of disadvantage are compared to outcomes for people living in more advantaged conditions.

Individual Level

Nurse-visited children born to high-resource mothers had higher rates of incoherent stories at age 6 years than their control group counterparts (ES = 0.32, P = .01). This program effect was not more pronounced among those with the dual risks of having mothers with low psychological resources and living in more disadvantaged neighborhoods at registration during pregnancy.

Outcomes reported for people living in conditions of disadvantage are compared to outcomes for people living in more advantaged conditions.

Individual Level

At age 6 years, nurse-visited children born to low resource mothers were less likely to have used therapeutic services (RR = 0.46, P = .01). They were less likely to have been enrolled in special education or remedial services in the first 3 years of elementary school (RR = 0.57, P = .06). The difference in use of therapeutic services was not significant in the period from ages 6 to 9 years.

Outcomes reported for people living in conditions of disadvantage are compared to outcomes for people living in more advantaged conditions.

Adaptability

Implementation History

Multiple implementations - Different settings/populations/providers - The intervention showed significant adaptability as it has been implemented in different settings or with different populations or by different provider(s). This can include multiple implementations during the same time period. Each implementation of the intervention must have been substantially the same and must have demonstrated positive results for the primary objectives of the intervention.

Expertise Required for Implementation within the Context of the Intervention

Requires specialized skills that are easily available within the context - The intervention requires the participation of personnel with advanced skills (e.g. medical doctors, epidemiologists, social workers) but that are easily available within the intervention context.

Are there supports available for implementation

Yes. The Nurse-Family Partnership National Service Office works with communities interested in implementing the Nurse-Family Partnership model to ensure the program is right for their needs and that broad-based community support can be established and sustaine

Are there resources and/or products associated with the interventions

Yes. Visit-to-visit guidelines, which provide a consistent structure for each of the 64 planned home visit; data collection system, reporting forms, and other quality assurance tools